Abstract
To elucidate the necessity of pyloroplasty for the gastric tube through the posterior mediastinum in esophageal surgery, gastric emptying and duodenogastric reflux (DGR) were evaluated in 16 cases undergoing an anterior pylorectomy (group P) and in 16 cases treated by the finger bougie method (group F). First, the obstruction and reflux symptoms were examined based on a patient questionnaire using a brief scoring system. The median value of the symptom score showed the patients in P to have more symptoms than those in F; however, the difference was not significant (8.0 vs 6.0). Secondly, the swallowed Tc O4 − (85 MBq) was counted using a gamma camera at three sites on the sternal bone in the upright position based on a gastric transit scintigram. Both the descending time of the RI peak and the clearance rates were similar between the two groups. Thirdly, intragastric 24-h pH monitoring was carried out. Antimony pH sensors were anchored 5 and 15 cm below the esophagogastrostomy. We could not find any difference between the two groups in both the % time pH>4 and %time pH>7. These findings thus revealed no big difference between groups P and F. The finger bougie method to drain the vagotomized posterior mediastinal stomach was found to achieve results similar to conventional pyloroplasty, while it was also simpler and safer.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Hai AA, Sigh A, Mittal VK (1986) Closed pyloroduodenal digital dilatation as a complementary drainage procedure to truncal vagotomy. Int Surg 71:87–90
Hirai T, Iwata T, Yamashita Y, Mukaida H, Toge T (1992) Investigation of suitability of devascuralized upper half of the whole stomach as replacement for the esophagus. Hiroshima J Med 41:25–30
Wangensteen OH (1958) A critique of operation for peptic ulcer. Postgrad Med 23:466–483
DeMeester TR, Wang CI, Wernly JA, Pellegrini CA, Little AG, Klementschitsch P, Bermudez G, Johnson LF, Skinner DB (1980) Technique, indication and clinical use of 24 hour esophageal pH monitoring. J Thorac Cardiovasc Surg 79:656–667
Cheung HC, Siu KF, Wong J (1986) Is pyloroplasty necessary in esophageal replacement by stomach? A prospective, randomized controlled trial. Surgery 102:19–24
Mannell A, McKnight A, Esser JD (1990) Role of pyloroplasty in the posterior mediastinal stomach: results of a prospective, randomized, controlled trial. Br J Surg 77:57–59
For M, Cheng SWK, Wong J (1991) Pyloroplasty versus no drainage in gastric replacement of the esophagus. Am J Surg 162:447–452
Domergue J, Veyrac M, Huin-Yan S, Rouanet P, Collet H, Michel H, Pujol H (1990) pH monitoring for 24 hours of gastroesophageal reflux and gastric function intrathoracic gastroplasty after esophagectomy. Surg Gynecol Obstet 171:107–110
Kauer WKH, Burdiles P, Ireland AP, Clark GWB, Peters JH, Bremner CG, DeMeester TR (1995) Does duodenal juice reflux into the esophagus of patients with complicated GERD? Evaluation of a fiberoptic sensor for bilirubin. Am J Surg 169:98–194
Yamashita Y, Hirai T, Yoshimoto A, Noma K, Kuwahara M, Iwata T (1996) Pyloroplasty and finger bougie for gastric replacement of the esophagus (in Japanese). Shujutsu (Operation) 50:415–418
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Yamashita, Y., Hirai, T., Mukaida, H. et al. Finger bougie method compared with pyloroplasty in the gastric replacement of the esophagus. Surg Today 29, 107–110 (1999). https://doi.org/10.1007/BF02482233
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02482233